Medical Management of Castration Resistant Prostate Cancer (CRPC): Beyond Chemotherapy

Ganesh K Bakshi¹, SK Raghunath², Sudhir Rawal³, Ganesh Gopalakrishnan⁴, Sanjai K Addla⁵, Priya J⁶, Suyog C Mehta⁷, Mrinal Borgohain⁷ and Rajan Mittal⁷*

Received: March 03, 2020, 2020;   Published: March 12, 2020

DOI: 10.32474/JUNS.2020.02.000146

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Abstract

Prostate cancer is one of the leading causes of cancer-related mortality in men. Despite advances in treatment options, about 30-40% of patients develop the advanced disease in due course. Androgen deprivation is the standard first-line systemic therapy for men with advanced prostate cancer. Almost all patients with the metastatic disease go on to develop castration-resistant prostate cancer. The multiple therapeutic alternatives for castration-resistant prostate cancer, including abiraterone acetate, enzalutamide, cabazitaxel, immunotherapy with sipuleucel-T, radiopharmaceuticals and bone-targeted therapies (zoledronic acid, denosumab) along with docetaxel have made the decision-making process complex and challenging for clinicians. Even the strong pipeline of systemic therapies with a diverse array of mechanisms of action in prostate cancer have shown preliminary signs of clinical benefit, leading to more definitive phase III confirmatory trials. The review will relate the pathogenesis to the management of castrationresistant prostate cancer and look for the best therapy approaches in metastatic castration-resistant prostate cancer, needed to tackle the existing challenges effectively.

Keywords: Castration Resistant Prostate Cancer; Prostate Cancer; AR signaling inhibitor; metastatic; asymptomatic

Abbreviations: GLOBOCAN: Global Cancer Incidence, Mortality and Prevalence; CRPC: castration-resistant prostate cancer; mPC: metastatic prostate cancer; mCRPC: metastatic castration-resistant prostate cancer; NM-CRPC: non-metastatic CRPC; FDA: Food and Drug Administration; PSA: prostate-specific antigen; EAU: European Association of Urology; AA: abiraterone acetate; RECIST: Response Evaluation Criteria in Solid Tumors; ADT: androgen deprivation therapy; LBD: ligand binding domain; MAPK : mitogenactivated protein kinases; BRCA: breast cancer gene; ATM: ataxia telangiectasia mutated; AUA: American Urological Association; NEPC: Neuroendocrine prostate cancer

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